骨关节炎患者全髋关节置换前后的骨折风险：使用双膦酸盐的潜在益处。

Fracture risk before and after total hip replacement in patients with osteoarthritis: potential benefits of bisphosphonate use.

作者信息

Prieto-Alhambra Daniel, Javaid M Kassim, Judge Andrew, Maskell Joe, Kiran Amit, de Vries Frank, Cooper Cyrus, Arden Nigel K

机构信息

University of Oxford, Oxford, UK.

出版信息

Arthritis Rheum. 2011 Apr;63(4):992-1001. doi: 10.1002/art.30214.

DOI:10.1002/art.30214

PMID:21452321

Abstract

OBJECTIVE

The association between osteoarthritis (OA) and fractures remains unclear. OA patients have increased bone mass, but no corresponding decrease in fracture rate. This study was undertaken to determine the fracture rates in patients with hip OA undergoing a total hip replacement (THR), as compared with disease-free controls, and to assess the association between bisphosphonate use and postsurgery fracture risk.

METHODS

We conducted a population-based parallel-cohorts study. All patients in the UK General Practice Research Database undergoing a THR for hip OA between 1986 and 2006 constituted the exposed cohort (n = 14,133). Five disease-free controls were matched with each patient by age, sex, and practice site. Subjects were followed up for 5 years before and after surgery. Fracture rates and rate ratios (RRs) were estimated using Poisson regression. In addition, bisphosphonate use was identified among patients undergoing THR, and the data, stratified by the presence or absence of a previous fracture and by treatment propensity score, were assessed using fitted Cox models to study the effect of bisphosphonate use on the risk of fracture postsurgery.

RESULTS

Patients undergoing a THR had a similar fracture risk as that in controls in the 5 years before THR, but had higher rates postsurgery, which peaked at years 2.5-5 (adjusted RR 1.24, 95% confidence interval [95% CI] 1.02-1.52). Use of bisphosphonates lowered the fracture risk among THR patients who received bisphosphonates as primary prevention (hazard ratio [HR] 0.56, 95% CI 0.38-0.82) and also among THR patients who had experienced a previous osteoporotic fracture (HR 0.48, 95% CI 0.23-0.99).

CONCLUSION

This study identified a 25% increase in fracture risk at 2.5-5 years postsurgery among patients undergoing a THR. Bisphosphonate use reduced the post-THR risk of fracture when administered both as primary prevention and as secondary prevention, by 44% and 52%, respectively. This must be further confirmed in randomized controlled trials.

摘要

目的

骨关节炎（OA）与骨折之间的关联尚不清楚。OA患者骨量增加，但骨折率却没有相应降低。本研究旨在确定行全髋关节置换术（THR）的髋OA患者与无病对照组相比的骨折率，并评估双膦酸盐使用与术后骨折风险之间的关联。

方法

我们进行了一项基于人群的平行队列研究。1986年至2006年间在英国全科医学研究数据库中因髋OA接受THR的所有患者构成暴露队列（n = 14,133）。按年龄、性别和执业地点为每位患者匹配5名无病对照。对受试者在手术前后进行5年随访。使用泊松回归估计骨折率和率比（RRs）。此外，在接受THR的患者中确定双膦酸盐的使用情况，并使用拟合的Cox模型对数据按既往有无骨折以及治疗倾向评分进行分层，以研究双膦酸盐使用对术后骨折风险的影响。

结果

接受THR的患者在THR前5年的骨折风险与对照组相似，但术后骨折率更高，在2.5 - 5年达到峰值（调整RR 1.24，95%置信区间[95%CI] 1.02 - 1.52）。双膦酸盐的使用降低了接受双膦酸盐作为一级预防的THR患者的骨折风险（风险比[HR] 0.56，95%CI 0.38 - 0.82），也降低了既往有骨质疏松性骨折的THR患者的骨折风险（HR 0.48，95%CI 0.23 - 0.99）。